OBJECTIVE: Uric acid (UA) to high-density lipoprotein cholesterol (HDL-C) ratio (UHR) has been recognized as a novel biomarker for evaluating inflammatory and anti-inflammatory interaction. However, it is not known whether UHR is related to abdominal aortic aneurysm (AAA). The current research aims to explore the potential role of UHR in predicting AAA. METHODS: In this study, 303 AAA patients and 408 normal subjects were retrospectively analyzed. The relationship between UHR and AAA was evaluated using Logistic regression models. Receiver operating characteristic (ROC) curves and restricted cubic spline (RCS) analysis were employed to elucidate the detailed association between UHR and AAA. RESULTS: UHR value in the AAA group was significantly higher than that in the normal group, and UHA was an independent risk factor for AAA. After adjusting for covariates, each 1-unit increase in UHR was associated with a 12% rise in AAA risk (OR: 1.12, 95% CI: 1.03, 1.21). ROC value of UHR was 0.847 (95% CI, 0.811~0.887, P < 0.05), and the optimal critical value of UHR was 17.2%. The incidence of AAA in the UHR≥17.2% group was significantly higher than that in the UHR < 17.2% group. RCS curves revealed a significant nonlinear relationship between UHR and AAA events (p-value < 0.001, p-nonlinear = 0.002). CONCLUSION: This study demonstrates that UHR levels are significantly linked to increased AAA risk, which can be widely used as an indicator for dynamic screening of AAA.